STROKE

Diagnosis and Assessment of Stroke

Table of Contents

Introduction3

Case Description.4

Main problems4

Analysis5

Locked-in Syndrome5

Brainstem stroke6

Comparison7

Link To Other Deficits7

Current Guidelines And Recommendations7

Psychosocial implications8

Conclusions.8

Main conclusions relevant to this case8

Recommendations For The Follow Up Of This Patient9

Recommendations For Assessment Of Gait In General10

Recommendations For Further Research10

References12

Annotated Bibliography17

Appendix22

The test evaluated22

Classification23

Diagnosis and Assessment of Stroke

Introduction

Stroke causes deficits and impairments that often lead to difficulties with walking and mobility. In the first week post-stroke, sixty-three percent of patients are unable to walk independently (Jorgensen et al., 1995). Most patients state that their main objective is their desire to be able to walk again (Pound et al., 1998). The assessment of gait and the subsequent choice of an outcome measure is problematic due to the many characteristics which make up the three basic requirements of walking. These are progression, (a basic locomotor pattern that successfully moves the body forwards), postural control and adaptation (Das & McCollum, 1988).

Three dimensional gait analysis is the current 'gold standard' in the assessment of gait deficits, however it is not widely used due to its high cost. Visual or observational gait analysis is widely used in clinical practice. It aims to highlight gait deviations by the therapist's analysis of visual information and requires a certain level of clinical skill. Little evidence exists to support its use. For these reasons a widely used clinical measure, the ten metre (10m) walk test (Collen, 1990) will be evaluated.

This case study concerns the assessment of post-stroke gait, in the clinical setting. The subject of this case study is a forty two year old man, presenting with bilateral symptoms following a brainstem stroke. Brainstem strokes account for eleven percent of all strokes (Ng, Stein, Ning, and Black-Schaffer, 2007).

Case Description.

This case study concerns the assessment of Mr. M who had a brain stem stroke on the 13th of December 2009. An MRI scan of the brain showed multiple infarctions (bilateral cerebellar, brainstem, pons and left thalamus), following dissection of the right vertebral artery with a partial thrombosis in the basilar artery. An intra-arterial thrombolysis was performed. He was noted to have an initial complete paralysis of both upper limbs, and lower limbs and an initial diagnosis of 'locked-in syndrome' (LIS) was made. Some active movement of the left lower limb having returned by two weeks post-stroke.

Mr. M has remained a patient until September 2010 at which point he was discharged with a view to a readmission in November 2010. The assessment details stated here concern this latest admission.

Main problems

On assessment Mr. M had the following problems;

Dysphagia (at that stage).

Dysarthria.

Spasticity in the upper and lower limbs more marked on the right side than the left. Difficulty with motor recruitment and weakness.

Joint contracture notably in the right ankle (and both shoulders).

Impaired balance. Frequent faller (five times in three weeks).

Impaired walking ability, walks outside using a rollator, otherwise uses one crutch. Difficulty due to a combination of spasticity, weakness and joint limitation.

Mr. M's perceived main problem is his limited ability to walk outside.

Gait Assessment

Indoors, ...